Viral or bacterial infections can occur in the middle of the ear. They often cause pain, inflammation, and fluid buildup. About 75% of children have at least one ear infection before they are 3 years old. Ear infections are the most common reason children see a doctor. Ear infections are well understood, and their frequency means that research is frequently conducted. This article explains the symptoms and causes of ear infections, the treatment options available.
Some facts about ear infections:
Here are some key points about ear infections.
Ear infections are more common in young boys than in young girls.
Most ear infections get better without treatment.
Vaccinating a child against the flu can help prevent ear infections.
Biofilms of antibiotic-resistant bacteria could be the cause of prolonged and repeated cases of ear infections.
Passive smoking increases the risk of ear infections.
What is an ear infection?
Ear infections are very common and affect 5 out of 6 children during their first 3 years. Otitis is a bacterial or viral infection of the middle ear. This infection causes inflammation and fluid buildup in the inner spaces of the ear. The middle ear is an air-filled space located behind the eardrum. It contains vibrating bones that convert sounds coming from outside the ear into meaningful signals for the brain. Ear infections are painful because inflammation and excess fluid buildup increase pressure on the eardrum.
An ear infection can be acute or chronic. Chronic infections can permanently damage the middle ear.
In adults, the symptoms are simple. Adults with an ear infection experience pain and pressure in the ear, fluid in the ear, and reduced hearing. Children show a wider range of signs. These include:
– pulling or pulling of the ear
– ear pain, especially when lying down
– difficulty sleeping
– loss of equilibrium
– difficulty hearing
– lack of appetite
Ear infections are generally divided into three categories.
Acute otitis media (AOM)
AOM is the most common and least serious form of ear infection. The middle ear becomes infected and swells, and fluid is trapped behind the eardrum. A fever may also occur.
Otitis media with effusion (OME)
After the ear infection has run its course, fluid may remain behind the eardrum. A person with OME may not have symptoms, but a doctor will be able to spot the remaining fluid.
Chronic otitis media with effusion (CMO)
COME is characterized by the repeated return of fluid to the middle ear, with or without the presence of an infection. This leads to a reduced ability to fight off other infections and has a negative impact on hearing ability.
An ear infection often starts with a cold, the flu, or an allergic reaction. These factors increase the amount of mucus in the sinuses and slow the evacuation of fluid through the Eustachian tubes. The initial illness also inflames the nasal passages, throat, and Eustachian tubes.
The role of the eustachian tubes
The Eustachian tubes connect the middle ear to the back of the throat. The ends of these tubes open and close to regulate air pressure in the middle ear, replenish that area with air, and drain normal secretions. A respiratory infection or allergy can block the Eustachian tubes, causing fluid to build up in the middle ear. An infection can occur if this fluid is infected with bacteria. The eustachian tubes of young children are smaller and more horizontal than those of older children and adults. This means fluid is more likely to build up in the tubes rather than drain out, increasing the risk of ear infection.
The role of adenoids
The adenoids are pads of tissue located at the back of the nasal cavity. They react to passing bacteria and viruses and play a role in the activity of the immune system. However, adenoids can sometimes hold bacteria. This can lead to infection and inflammation of the Eustachian tubes and middle ear. The adenoids are close to the openings of the Eustachian tubes and, if they swell, they can cause the tubes to close. Children have relatively large and more active adenoids than those of adults. Children are therefore more susceptible to contracting ear infections.
Infants under 6 months of age need antibiotic treatment to help prevent the spread of infection. Amoxicillin is often the antibiotic of choice. For children 6 months to 2 years old, doctors usually recommend monitoring the child without giving them antibiotics unless they show signs of a serious infection. Ear infections often go away without treatment, and the only medication needed is pain management. Antibiotics are only used in more severe or prolonged cases.
You have to be careful about these points:
– children aged 6 to 23 months who have mild inner ear pain in one ear for less than 48 hours and a temperature below 39° Celsius
– children aged 24 months and over with mild inner ear pain in one or both ears for less than 48 hours and a temperature below 39° Celsius
– For children over 2 years of age, antibiotics are not normally prescribed. Overuse of antibiotics leads to antibiotic resistance. This can mean that serious infections become more difficult to treat.
A warm compress, such as a towel, can soothe the affected ear.
Ear infections are extremely common, especially in children. This is due to an immature immune system and differences in ear anatomy. There is no guaranteed way to prevent infections, but there are a number of recommendations to reduce the risk:
Vaccinated children are less likely to get ear infections. Ask your doctor about meningitis, pneumococcal and flu vaccinations.
Wash your hands and your child’s hands often. This will prevent you from transmitting bacteria to your child and you will help him or her not catch a cold or the flu.
Avoid exposing your child to second-hand smoke. Infants who spend time with smokers are more likely to get ear infections.
Breastfeed infants when possible. This helps to boost their immunity.
When bottle feeding an infant, do so in a seated position to reduce the risk of milk leaking into the middle ear. Don’t let a baby suck on a bottle while lying down.
Do not use antibiotics unless necessary. Ear infections are more likely in children who have had an ear infection in the previous 3 months, especially if they have been treated with antibiotics.
Ear infections are part of most people’s childhood. They can be painful, but they present very few long-term problems if properly cared for.
Heikkinen, T. & Chonmaitree, T. (2003). Importance of respiratory viruses in acute otitis media. Clinical Microbiology Reviews, 16(2), 230-241
NIDCD fact sheet: Ear infections in children. (nd)
Stoodley, L., Hu, FZ, & Gieseke, A. (2006, July 12). Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media. JAMA, 296(2), 202-211
Wren, JT, Blevins, LK, Pang, B., Perez, AC, Murrah, KA, Reimche, JL, … & Swords, WE (2014, November). Influenza A virus alters pneumococcal nasal colonization and middle ear infection independently of phase variation [Abstract]. Infection and Immunity, 82(11), 4802-4812
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